Tic douloureux

Trigeminal neuralgia is a condition that is characterized by the recurrent short episodes of intense pain in the innervation area of one or more branches of the trigeminal nerve. This chronic disease usually affects people over the age of 50. It is more common in women than in men. The overall incidence is about 3-4 cases per 100.000 of population per year.

Trigeminal neuralgia – Diagnostics

Trigeminal neuralgia is diagnosed on the basis of the clinical manifestations of the disease. A diagnosis is confirmed in presence of four out of five criteria determined by the International Headache Society:

• Pain is located in the trigeminal nerve branches innervation areas.
• In one patient pain episodes are always identical.
• Pain is sudden, sharp, like an electric shock. It is caused by mechanical irritation of the face, chewing, or contraction of facial muscles.
• Pain decreases after the carbamazepine intake.
• Absence of a pain in the interictal period.

Instrumental methods help in diagnostics. They are necessary for revealing causes of the pathology. These techniques are:

• MRI (magnetic resonance imaging) allows to detect the brain tumours, multiple sclerosis and other neurological diseases. An MRI scan is able to detect the proximity of the blood vessel to the branches of the trigeminal nerve, which is revealed in approximately 85% of patients.
• CT (computed tomography) is a less expensive as well as less informative alternative to MRI.
• Electroneurogram determines the speed of impulses along nerves. It allows to reveal demyelination of the trigeminal nerve (the degradation of the myelin sheath in the place of contact with the blood vessel).

If the symptomatic trigeminal neuralgia is suspected, a number of other laboratory and instrumental examinations can be performed and the choice depends on the basic disease.

Best clinics for the trigeminal neuralgia diagnostics in Germany:

Charite University Hospital Berlin

0.00

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Helios Hospital Berlin-Buch

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Beta Clinic Bonn

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Trigeminal neuralgia – Treatment

In case of secondary (symptomatic) trigeminal neuralgia therapy of the basic disease is required. Treatment of primary trigeminal neuralgia requires conservative or surgical methods.

• Drug therapy is used to treat the majority of patients. Antiepileptic medicines are prescribed. When the main therapeutic effect is reached, the dose is reduced up to the supportive one and the patient takes it life-long. Eventually, an addiction may develop and the dose might be increased again. If a person refuses the treatment, the pain occurs again with time.
• Physiotherapy and reflexotherapy are additional methods that provide only a temporary and poorly expressed effect. 
• Intraosseous blockades are used in case of the ineffectiveness of drug therapy. Anaesthetics are injected into the skull bone. Several of these procedures can reduce the severity of pain in some patients for a period from 1 to 6 months.
• Microvascular decompression is a neurosurgical intervention. It is performed in the case of the primary (idiopathic) neuralgia. The essence of the surgery is to relieve the abnormal compression of the branches of the trigeminal nerve and the adjacent blood vessel. Basically it is the front or posterior inferior cerebellar artery, basilar or vertebral one. A protector is set between vessels and nerves. The operation causes the throbbing artery to cease irritating the nerve and neuralgia symptoms disappear.

Best clinics for the trigeminal neuralgia treatment in Germany:

Charite University Hospital Berlin

Diagnosis and conservative treatment of trigeminal neuralgia

10659.38

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Treatment of trigeminal neuralgia by microvascular decompression of trigeminal nerve root

27559.05

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Bundeswehr Hospital Berlin

Diagnosis and conservative treatment of trigeminal neuralgia

7088.826588.82

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Treatment of trigeminal neuralgia by microvascular decompression of trigeminal nerve root

18423

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University Hospital of Ludwig Maximilian University of Munich

Diagnosis and conservative treatment of trigeminal neuralgia

8418.96

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Treatment of trigeminal neuralgia by microvascular decompression of trigeminal nerve root

18487.73

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Trigeminal neuralgia– Rehabilitation

The most modern rehabilitation programs are used in Germany. They are adapted individually for each patient, and are based on the disease stage, age, physical possibilities, and the results of treatment. Different specialists such as: therapists, neurologists, psychologists, rehabilitators, kinesiotherapists, physiotherapists are involved in the rehabilitation process.

The following methods of rehabilitation are used:

• Dosed physical activity
• Training on the simulators and in the pool
• Individual orthoses
• Physiotherapy
• Acupuncture
• Manual therapy
• Transcranial magnetic stimulation
• Natural factors of the nature (mud, thermal waters, etc.)
• Individual or group therapy with a psychologist

Rehabilitation may include medicamentous support. It is necessary to hold a consultation with the patient about the proper nutrition and the way of life which is important for him in the current situation.

Rehabilitation programs in Germany are designed for 2 weeks. If necessary, they can last much longer. In this country, the patient is provided with qualitative care, accommodation in comfortable rooms and individually selected meals.

Rehabilitation programs in Germany show one of the best results in the world. Most patients successfully restore their working capacity and excellent health there. They remain physically active, return to the full social and family life.

Best clinics for neurological rehabilitation in Germany:

Neurological Rehabilitation Clinic Godeshöhe Bonn

1800.00Per day

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Author:

The article was edited by medical expert, board certified Dr. Nadezhda Ivanisova. For the treatment of the conditions referred to in the article you must consult a doctor; the information in the article is not intended for self-medication!

Sources:

Medscape

Sience Direct

The Lancet